Anorexia Nervosa – Highest Mortality Rate of Any Mental Disorder: Why?

While all eating disorders are dangerous mental health conditions, anorexia nervosa (AN) has the unfortunate distinction of being the deadliest eating disorder—and, by some accounts, the deadliest psychiatric disorder.¹

There are a number of risks that make AN particularly dangerous, but learning more about the associated death rate can help you recognize the importance of identifying warning signs and seeking help.

Understanding Anorexia Nervosa

Anorexia nervosa is a mental health disorder marked by an extreme fear of gaining weight and a distorted view of one’s own body.² People with this issue generally equate their self-worth with their body weight, shape, size, or appearance.³

People with AN regularly engage in behaviors to prevent weight gain or actively lose weight, with severely limiting food intake a common method. People with this condition are also frequently in denial of a problem or fail to recognize how dangerous their behavior is.²

In a majority of cases, AN is connected to some combination of depression, anxiety, previous trauma, substance use, and chronically low self-esteem, with the disordered behaviors sometimes developing as a maladaptive coping mechanism for these unpleasant experiences.^4,5

Coupled with the dangerous eating behaviors the disorder encourages and a general disinterest in seeking help, these co-occurring conditions can make AN particularly tricky to treat and very often deadly if not appropriately treated.

Mortality Rates in Anorexia Nervosa

Since AN is frequently connected to so many other psychiatric disorders and mental and physical complications, it can be difficult to calculate a comprehensive anorexia death rate.

By some counts, anywhere from 5-10% of people with anorexia nervosa will die within 10 years of developing the condition, and 18-20% will die within 20 years. Compared to all females in the general population between ages 15-24, the anorexia death rate is 12 times higher.⁶

It’s also higher than mortality rates for other eating disorders, including bulimia nervosa (BN), which has an overall death rate of around 3.9%, and eating disorders not otherwise specified (EDNOS), with a rate of approximately 5.2%.⁷ 

The physical issues caused by severe malnutrition and starvation can wreak havoc on the body, leading to many potentially deadly complications. The mental aspects of the disorder can introduce other risks, particularly the risk of dying by suicide, which is 18 times higher for people with AN compared to people without an eating disorder.⁹

Causes of Death in Anorexia Nervosa

The high death rate of anorexia can be attributed to a number of causes.

Physical Complications

About a third of deaths associated with anorexia are due to heart damage — mainly “sudden death,” which happens when the heart suddenly stops working due to cardiovascular complications. Other heart issues from anorexia include irregular rhythms, heart muscle shrinkage, and cardiomyopathy, which makes it harder for the heart to pump blood. .¹⁰

The electrolyte imbalances caused by vomiting and laxatives can also lead to heart failure and death.¹¹ 

Prolonged starvation can also result in failure of the brain, liver, intestines, and kidneys.¹²

Once someone starts receiving treatment for anorexia, they can still be at risk of dying. Refeeding syndrome is a potentially deadly complication of severe anorexia nervosa caused by complications involved with reintroducing nutrition to the body after a period of starvation.¹³

Mental Health Complications

One factor that contributes to the high death rate of anorexia is the condition’s impact on mental health.

AN is highly comorbid (co-occurring) with other mental health conditions, including:¹⁴

• General anxiety disorder
• Major depressive disorder
• Other mood or affective disorders
• Substance use disorder
• Obsessive compulsive disorder
• Bipolar disorder

In some cases, patients may struggle with more than one of these conditions while simultaneously battling AN.

Sadly, suicide accounts for 25% of deaths associated with anorexia nervosa.²  This is due to multiple factors, including co-occurring conditions.. One study found that those with AN who also had alcohol use disorder were at a particularly high risk of suicide attempts.¹

Long-Term Health Impacts

Anorexia, especially severe anorexia nervosa, can cause a multitude of long-term impacts on health that can become increasingly problematic with time.

Osteoporosis is a common symptom of AN, and, in rare cases, severe osteoporosis can contribute to death.² The impact of anorexia on the liver can also turn deadly.¹ Malnutrition can suppress the immune system, increasing the risk of infectious diseases like pneumonia, which can be fatal.^1,15

AN has also been connected to a number of dental problems, which can cause painful and irreversible damage.⁴ People with anorexia nervosa and diabetes also have a higher risk of premature death.¹

Anorexia Death Rate: High-Risk Groups

While AN impacts people of all ages, genders, races, sexual orientations, and ethnicities, some people are at a higher risk of dying from the condition.

Even though anorexia is more common in females, large-scale studies have found the death rate in men with anorexia is more than twice that of women.^1,16 

A nationwide study in Denmark also found that those who had a co-occurring mental health condition with anorexia had an almost two-fold increase in 10-year mortality compared to those without a co-occurring disorder. There was also a fourfold increase in mortality when patients were diagnosed with anorexia between the ages of 6 and 25.¹⁷A greater percentage of weight loss from a person’s ideal body weight and a longer length of illness also increase the risk of death.¹⁸

Treatment and Its Impact on the Anorexia Death Rate

The eating disorder statistics related to anorexia deaths can feel grim, but they don’t have to be set in stone. It’s possible to treat many of the medical complications connected to the condition, including the underlying mental health issues that drive the eating disorder.

Family-based therapy (FBT) has been found to be particularly helpful, especially for younger patients.¹ This method incorporates parents or other caretakers in therapy to help the group learn how to create a home environment conducive to recovery. Other psychotherapeutic techniques, like cognitive behavioral therapy (CBT), can also help alleviate eating disorder symptoms related to AN.

A number of medical interventions can help with physical complications, including invasive procedures in life-threatening instances. Once patients are medically stable, they can undergo nutritional counseling to better understand how to maintain a healthy, balanced diet. Medications can also help alleviate physical symptoms or psychological issues that may help maintain the disorder.

In any case, eating disorder treatment is most effective when started early. Early intervention has been shown to improve treatment outcomes and help people reach remission more quickly.¹⁹

Finding Help for Anorexia Nervosa

People with eating disorders like anorexia nervosa face an increased risk of premature death, but with the right kind of care and support, the condition is entirely beatable.

Contacting a physician, psychiatrist, therapist, or other licensed medical professional will give you the best idea of how to proceed. These professionals can help you receive an official diagnosis and find an eating recovery center nearby.

But if you or a loved one is struggling with anorexia nervosa, the most important thing is never to give up hope. Anorexia doesn’t have to be a death sentence. Help and healing are always possible.